Request

Fill in this form and we’ll deliver a Lactacyd sample right to your doorstep!

Name:

Identification Card Number:

Email:

Contact No.:

Ethnicity:

Do you currently use feminine wash?

What brand do you use most often?

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Date of birth:

Address:

Postcode:

State:

Country:

Do you share it with anyone at home?

What other brands do you use?

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I hereby agree to the Terms and Conditions stated and consent to the use of my personal data in the manner and for the purposes stipulated in the PDPA.I would like to be part of the upcoming V-Royalty program to enjoy special Lactacyd privileges and promotions.